1. DESIGNED FOR DISEASE: The Link Between Local Food Environments and Obesity & Diabetes Stefan Harvey California Center for Public Health Advocacy BANPAC, June 4, 2008

2. Study Partners

3. The Study: Data Sources  Health and demographic data from the 2005 California Health Interview Survey (CHIS)  Locations of retail food outlets from the 2005 InfoUSA Business File  2000 Census data on community income

4. Retail Food Environment Index (RFEI) Fast-Food Restaurants + Convenience Stores Grocery Stores + Produce Vendors RFEI =

5. Higher RFEI = Higher Obesity Rates 20% 23% 24% 0% 5% 10% 15% 20% 25% RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+ * *

6. Higher RFEI = Higher Diabetes Rates 6.6% 7.8% 8.1% 0% 3% 6% 9% RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+ * *

7. Higher RFEI = Higher Diabetes Rates 6.6% 7.8% 8.1% 0% 3% 6% 9% RFEI < 3.0 RFEI 3.0 - 4.9 RFEI 5.0+ * * 23% difference

8. Higher RFEI in Lower-income Communities 4.9 4.1 0 1 2 3 4 5 6 Lower-income Communities Higher-income Communities *

9. Higher RFEI in Lower-income Communities 4.9 4.1 0 1 2 3 4 5 6 * 20% difference Lower-income Communities Higher-income Communities

10. RFEI & Obesity in Lower-income communities 24% 26% 28% 0% 10% 20% 30% Lower-income Communities RFEI < 3.0RFEI 3.0 - 4.9RFEI 5.0+ *

11. RFEI & Obesity in Lower-income communities 24% 26% 28% 0% 10% 20% 30% Lower-income Communities RFEI < 3.0RFEI 3.0 - 4.9RFEI 5.0+ * 17% difference

12. RFEI & Diabetes in Lower-income Communities 7.7% 8.5% 9.3% 0% 2% 4% 6% 8% 10% Lower-income Communities RFEI 3.0 - 4.9RFEI 5.0+ ** RFEI < 3.0

13. RFEI & Diabetes in Lower-income Communities 7.7% 8.5% 9.3% 0% 2% 4% 6% 8% 10% Lower-income Communities RFEI 3.0 - 4.9RFEI 5.0+ ** RFEI < 3.0 21% difference

14. Findings hold true after controlling for age, gender, ethnicity, individual income, community income, and physical activity levels  California adults with an RFEI ≥ 5.0 are 18% more likely to be obese than adults with an RFEI < 3.0  California adults with an RFEI ≥ 5.0 are 24% more likely to have a diagnosis of diabetes than adults with an RFEI < 3.0

15. Conclusions  Strong and direct link between the local food environment and both obesity and diabetes  Food environment affects communities across California  RFEI, obesity, and diabetes are all highest in lower-income communities

16. Policy Recommendations  Improve access by incentivizing retail store development and improvement  Promote retail innovations, including smaller- scale markets, selling healthy foods  Require chain restaurants to post nutritional information on menus and menu boards

17. Policy Recommendations  Establish zoning ordinances to limit fast food outlets in overburdened communities  Maximize the opportunities presented by the changes in the WIC food package  Target obesity and diabetes prevention efforts to lower-income communities

18. WWW. P ublic H ealth A dvocacy.Org

19. DESIGNED FOR DISEASE: The Link Between Local Food Environments and Obesity & Diabetes Stefan Harvey California Center for Public Health Advocacy BANPAC, June 4, 2008